Initial Antibiotic Treatment Fails in Nearly One in Four Pneumonia Patients, Study Finds

An initial antibiotics regimen fails to cure pneumonia in one in four patients who acquire the disease outside hospitals and care facilities, according to a study.

The failures lead to additional rounds of treatments, emergency-room visits and hospitalizations, the researchers said.

Elderly patients are particularly prone to antibiotic failure, they added. In fact, their risk of treatment failure is so high that doctors should consider more aggressive treatment from the start, they said.

Community-acquired pneumonia is the term researchers use for cases developed outside care facilities.

“Pneumonia is the leading cause of death from infectious disease in the United States, so it is concerning that we found nearly one in four patients with community-acquired pneumonia required additional antibiotic therapy, subsequent hospitalization or emergency room evaluation,” Dr. James A. McKinnell, the study’s lead researcher, said in a news release. “The additional antibiotic therapy noted in the study increases the risk of antibiotic resistance and complications like C. difficile (“C diff”) infection, which is difficult to treat and may be life-threatening, especially for older adults.”

The study was based on medical records of nearly 251,950 adults who received an initial regimen of beta-lactam, macrolide, tetracycline, or fluoroquinolone for their pneumonia between 2011 and 2015.

Researchers defined treatment failure as cases in which patients had to change their prescription, switch to another antibiotic, be admitted to an emergency room or be hospitalized within a month of starting treatment.

“Our findings suggest that the community-acquired pneumonia treatment guidelines should be updated with more robust data on risk factors for clinical failure,” McKinnell said. “Our data provide numerous insights into characteristics of patients who are at higher risk of complications and clinical failure.”

The antibiotic failure rate was 22.1 percent, the team discovered. Rates were higher among older patients or those with health conditions besides pneumonia.

“Perhaps the most striking example is the association between age and hospitalization,” McKinnell said. “Patients over the age of 65 were nearly twice as likely to be hospitalized compared to younger patients when our analysis was risk-adjusted and nearly three times more likely in unadjusted analysis. Elderly patients are more vulnerable and should be treated more carefully, potentially with more aggressive antibiotic therapy.”

The failure rates by class of antibiotic were 25.7 percent for beta-lactams, 22.9 percent for macrolides, 22.5 percent for tetracyclines, and 20.8 percent for fluoroquinolones.

Another finding was that patient outcomes differed by region.

The team said many doctors failed to follow guidelines that call for combo therapies or respiratory fluoroquinolone to treat pneumonia patients with other conditions, such as chronic obstructive pulmonary disease (COPD), cancer or diabetes. The American Thoracic Society and the Infectious Disease Society of America developed the guidelines.

“While certain aspects of the guidelines need to be updated, some prescribers also have room for improvement and should implement the current guidelines,” McKinnell concluded.